PSA Flashcards
(188 cards)
1
Q
enzyme inducers?
A
PC BRAS: Phenytoin, Carbamazepine, Barbiturates, Rifampicin, Alcohol (chronic excess), Sulphonylureas
2
Q
enzyme inhibitors?
A
AODEVICES: Allopurinol, Omeprazole, Disulfiram, Erythromycin, Valproate, Isoniazid, Ciprofloxacin, Ethanol (acute intoxication), Sulphonamides
3
Q
patient on warfarin started on erythromycin for infection. what happens?
A
the addition of erythromycin (an enzyme inhibitor) can sometimes and unpredictably cause a dangerous rise in international normalized ratio (INR) if the warfarin dose is not decreased
4
Q
drugs to stop before surgery?
A
I LACK OP: Insulin, Lithium, Anticoagulants/antiplatelets, COCP/HRT, K-sparing diuretics, Oral hypoglycaemics, Perindopril and other ACE-inhibitors.
5
Q
when to stop COCP/HRT before surgery?
A
4 weeks before surgery
6
Q
when to stop Li before surgery?
A
day before
7
Q
when to stop ACEi before surgery?
A
day of
8
Q
when to stop anticoag/antiplatelet before surgery?
A
variable
9
Q
when to stop oral hypoglycaeimc/insulin before surgery?
A
variable
10
Q
patient on long term steroids and for surgery. what do?
A
double daily steroid dose before induction of anaesthesia. (sick day rules)
11
Q
PReSCRIBER mnemonic?
A
Patient details Reaction (i.e. allergy plus the reaction) Sign the front of the chart check for Contraindications to each drug check Route for each drug prescribe Intravenous fluids if needed prescribe Blood clot prophylaxis if needed prescribe antiEmetic if needed and prescribe pain Relief if needed.
12
Q
Does co-amoxiclav have penicillin?
A
yes
13
Q
SE/Contraindications for steroids?
A
STEROIDS: Stomach ulcers, Thin skin, oEdema, Right and left heart failure, Osteoporosis, Infection (including Candida), Diabetes (commonly causes hyperglycaemia and uncommonly progresses to diabetes), and Cushing’s Syndrome.
14
Q
safety considerations with NSAIDS? (CI for nsaids)
A
NSAID: No urine (i.e. renal failure), Systolic dysfunction (i.e. heart failure), Asthma, Indigestion (any cause), and Dyscrasia (clotting abnormality).
15
Q
anti-HTN, main SEs?
A
A) Hypotension (including the earliest symptom, postural hypotension) that may result from all groups of antihypertensives.
B)mechanistic categories:
1.
Bradycardia may occur with beta-blockers and some calcium-channel blockers.
2.
Electrolyte disturbance can occur with angiotensin converting enzyme (ACE)-inhibitors and diuretics (see Chapter 3).
C)
Individual drug classes have specific side effects:
1.
ACE-inhibitors can result in a dry cough.
2.
Beta-blockers can cause wheeze in asthmatics; they can also cause worsening of acute heart failure (but help chronic heart failure).
3.
Calcium-channel blockers can cause peripheral oedema and flushing.
4.
Diuretics can cause renal failure. Thiazide diuretics (e.g. bendroflumethiazide) can also cause gout, and potassium-sparing diuretics (e.g. spironolactone) can also cause gynaecomastia.
16
Q
Common SE ACEi
A
dry cough
17
Q
Common SE BB
A
wheeze in asthmatic, worsen acute HF
18
Q
Common SE CCB
A
peripheral oedema and flushing
19
Q
Common SE diuretics, thiazide and K sparing
A
Diuretics can cause renal failure.
Thiazide can cause gout
K sparing can cause gynaecomastia
20
Q
should you give NBM patient oral medication, including before surgery?
A
YES
21
Q
Fluid replacement - when not to give normal saline?
A
- hypernateraemic or hypoglycaemic - give 5% dextrose
- has ascites - give human albumin solution (HAS) instead. [The albumin maintains oncotic pressure; furthermore, the higher sodium content of 0.9% saline will worsen ascites.]
- shocked from bleeding - blood tranfusion, but if taking long time give crystalloid in meantime. NO COLLOID.
22
Q
fluid assessment - pt only oliguric (<30ml/hr) with no urinary obstruction (eg. BPH)
A
normal saline 1L over 2-4 hours then reassess
23
Q
fluid assessment - pt tachy or hypo
A
normal saline 500ml bolus (15min) then reassess [HR, BP, UO]. (250ml if HF)
24
Q
rough prediciton of amount of fluid depletion from HR, BP and UO?
A
reduced urine output (oliguric if <30 mL/h; anuric if 0 mL/h) indicates 500 mL of fluid depletion
•
reduced urine output plus tachycardia indicates 1 L of fluid depletion
•
reduced urine output plus tachycardia plus shocked indicates >2 L of fluid depletion.
25
max IV K rate?
cannot give more than 10mmol/hr
26
Maintenance fluids?
adults 3L. Elderly 2L (per day)
Adequate electrolytes are provided by 1 L of 0.9% saline and 2 L of 5% dextrose (1 salty and 2 sweet).
•
To provide potassium, bags of 5% dextrose or 0.9% saline containing potassium chloride (KCl) can be used but this should be guided by urea and electrolyte (U&E) results; with a normal potassium level, patients require roughly 40 mmol KCl per day (so put 20 mmol KCl in two bags)
27
how often to give maintenance fluids bags?
if 3L ; 8 hourly (24/3)
| if 2L; 12 hourly (24/2)
28
what to do before Rx fluids?
check U&E.
check no fluid overload - eg. increased JVP, peripheral or pulmonary oedema
check bladder not palpable- if palpable shows urinary obstruciton
29
CI to compression stockings?
peripheral arterial disease
30
CI to prophylactic LMWH?
active bleeding / risk of bleeding (eg. ischaemic stroke)
31
CI for metoclopramide (DA antagonist) ?
PD patient
| young woman - risk of dyskinesia, esp dystonia.
32
Antiemetic choice if nauseated?
REGUALR
- cyclizine 50 mg 8 hourly IM/IV/oral for most cases but causes fluid retention
- metoclopramide 10 mg 8 hourly IM/IV if heart failure
- ondansetron 4mg or 8mg 8-hourly IV/oral
33
CI for cyclizine?
cyclizine is a good first-line treatment for almost all cases except cardiac cases (as it can worsen fluid retention), where metoclopramide 10 mg 8 hourly IM/IV/oral is safer.
34
antiemetic choice if not nauseated?
AS REQUIRED
- cyclizine 50 mg up to 8 hourly IM/IV/oral for most cases but causes fluid retention
- metoclopramide 10 mg up to 8 hourly IM/IV if heart failure
35
Analgesia - No pain
Regular - Nil
| As required- Paracetamol 1g up to 6 hourly oral
36
Analgesia - Mild pain
regualr - Paracetamol 1g up to 6 hourly oral
| as required - 30mg up to 6 hourly oral
37
Analgeisa - Severe pain
regualr - cocodamol (30/500),2 tablets 6 hourly
| as required - morphine sulphate (10mh/5ml) 10mg up to 6 hourly oral
38
when to add nsaid for pain?
An NSAID (e.g. ibuprofen 400 mg 8 hourly) may be introduced at any stage regularly or ‘as required’ if not contraindicated.
39
neuropathic pain?
the first line treatment is amitriptyline (10 mg oral nightly) or pregabalin (75 mg oral 12 hourly);
40
diabetic neuropathy pain?
duloxetine (60 mg oral daily)
41
paracetamol daily max dose?
4 g
| so max 1g 6 hourly
42
pt <50kg , max paracetamol dose?
max 500mg 6 hourly
| so 2g/day max.
43
electrolytes and thiazides?
thiazides like bendroflumethazide (eg. Neo-naclex) can cause low K
NB loop and thiazides both cause low K
44
electrolyes and ACEi?
can cause hyper K
45
domperidone v metoclopramide?
both DA antagonists
metoclopramide can cross BBB act on DA receptors so CI in PD
domperidone cannot corss BBB, so fine in PD.
46
why gastric discomfort with nsaid/ibuprofen?
Ibuprofen inhibits prostaglandin synthesis needed for gastric mucosal protection from acid. It is therefore at risk of influencing inflammation and ulceration.
47
why gastric discomfort with steroids>?
Oral steroids inhibit gastric epithelial renewal, thus predisposing to ulceration.
48
why low renal function and NSAIDs?
Ibuprofen inhibits prostaglandin synthesis which reduces renal artery diameter (and blood flow) and thereby reduces kidney perfusion and function.
49
why low renal func and ACEi?
Ramipril, an ACE-inhibitor, reduces angiotensin-II production necessary for preserving glomerular filtration when the renal blood flow is reduced.
50
ACEi and NSAIDs together on renal func?
In effect, NSAIDs combined with ACEi are a double threat to renal perfusion. The combination nips tight the afferent artery (the way in) and opens up the efferent artery (the way out).
51
why ACEi and dry cough?
ACE-inhibitors are thought to cause a dry cough through accumulation of bradykinin via reduced degradation by ACE.
52
why ACEi and hyper k?
ACE-inhibitors cause hyperkalaemia through reduced aldosterone production and thus reduced potassium excretion in the kidneys
53
antimuscarinic drugs and elderly?
Oxybutynin is an antimuscarinic drug, used for the treatment of urinary frequency/urgency. Antimuscarinic drugs can cause confusion, particularly in the elderly. While many drugs can precipitate acute confusion in elderly patients, the clues in this case are the accompanying symptoms – antimuscarinic agents commonly cause pupillary dilation, with loss of accommodation, dry mouth, and tachycardia (after a transient bradycardia). This is a typical presentation of antimuscarinic toxicity. Of note, the British National Formulary (BNF) recommends a lower dose of oxybutynin in elderly patients.
54
elderly pt with new confusion - ddx?
, including acute intracranial event, infection, electrolyte disturbance, urinary retention, and/or constipation
55
some drug causes of acute confusion in elderly?
Tramadol -an opioid, is notorious for causing confusion in the elderly and ought to be avoided unless absolutely necessary. It is an unwise choice of analgesic for the treatment of osteoarthritis
Cyclizine, an antiemetic, can cause drowsiness and confusion, based partly on its propensity to cause anticholinergic effects. Reduced doses are recommended in elderly patients.
Diazepam, a benzodiazepine, should be used with extreme caution in the elderly and only for short courses
56
nsaids and methotrexate?
Ibuprofen and other NSAIDs should be used with caution in patients on methotrexate due to an increased risk of nephrotoxicity
57
trimethoprim and methotrexate?
Trimethoprim is a folate antagonist, and is a direct contraindication to patients taking methotrexate (another folate antagonist) due to the risk of bone marrow toxicity. This can lead to pancytopenia and neutropenic sepsis. The trimethoprim should therefore be stopped.
58
infection and methotrexate?
Methotrexate is contraindicated in active infection and should be withheld. Owing to it’s long half life, one missed dose should not affect control of the RA.
59
post TIA and heparin proph?
This patient suffered an acute stroke one week ago and should therefore not be taking heparin thromboprophylaxis during this initial period (the exact period varies throughout the UK but is typically a few months).
60
verapamil and BB?
Verapamil should not be used with beta-blockers due to the risk of bradycardia (or at worst asystole) and hypotension (unless under expert supervision).
61
insulin for DM, IV or SC?
Novomix 30® (a combination of short and medium acting insulin) is never given IV; as a rule all insulin is s/c except for sliding scales using short-acting insulin (e.g. Actrapid® or NovoRapid®) given by IV infusion.
62
steroids and FBC?
may cause neutrophilia
63
2 drugs causing neutropenia
clozapine (antipsychotic), carbimazole (antithyroid)
64
drugs causing low platelets?
penicillamine (in RA tx) --> reduced production
| heparin --> increased destruction
65
causes of hyponatreamia?
hypovolaemic : fluid loss, diuretics, Addisons'
euvolaemic: SIADH, psychogenic polydipsia, hypothyroid
hypervolaemic: HF, renal failure, liver failure (causing hypoalbuminaemia), nutritional failure (causing hypoalbuminaemia), thyroid failure (hypothyroid)
66
causes of hypernatraemia?
all with 'd'
dehydration; drips (i.e. too much IV saline); drugs (e.g. effervescent tablet preparations or intravenous preparations with a high sodium content); diabetes insipidus (which is effectively the opposite of syndrome of inappropriate antidiuretic hormone (SIADH).
67
causes of hypokalaemia
```
DIRE
diuretics - loop and thiazide
Inadequate intake or intestinal loss (d&v)
renal tubular acidosis
endo (Cushing's and Conn's)
```
68
causes of hyperkalaemia
```
DREAD
drugs (k sparing diuretics and ACEi)
endo (Addisons)
artefact (clotted sample)
DKA (note that when insulin is given to treat DKA the potassium drops, requiring regular (hourly) monitoring +/− replacement )
```
69
nephrotoxic abx?
gentamicin, vancomycin, tetracyclines
70
causes of intrinsic AKI
```
INTRINSIC
Ischaemia (due to prerenal AKI, causing acute tubular necrosis) Nephrotoxic antibiotics∗∗
Tablets (ACEI, NSAIDs)
Radiological contrast
Injury (rhabdomyolysis)
Negatively birefringent crystals (gout)
Syndromes (glomerulonephridites)
Inflammation (vasculitis)
Cholesterol emboli
```
71
a raised urea with normal creatinine in a patient who is not dehydrated (i.e. does not have prerenal failure)?
upper GI bleed
72
drugs causing biliary cholestasis?
Flucloxacillin, CO-AMOXICLAV, nitrofurantoin, steroids and sulphonylureas.
73
TSH target range?
target range ∼0.5–5 mIU/L
74
gentamicin - high serum level (without signs of toxicity); what do?
pre-empt a decrease in frequency by 12 h rather than reducing the dose, e.g. changing from every 24 h (daily) to every 36 h
75
digoxin toxicity?
Confusion, nausea, visual halos, and arrhythmias
76
Li toxicity?
Early: coarse tremor
Intermediate: tiredness
Late: arrhythmias, seizures, coma, renal failure, and diabetes insipidus
77
phenytoin toxicity?
Gum hypertrophy, ataxia, nystagmus, peripheral neuropathy, and teratogenicity, dysarthria
78
gentamicin toxicity?
Ototoxicity and nephrotoxicity
79
vancomycin toxicity?
Ototoxicity and nephrotoxicity
80
warfarin , INR 5-8
if no bleeding - Omit warfarin for 2 days then reduce dose
| if bleeding - Omit warfarin and give 1-5mg IV vitamin K
81
warfarin, INR >8
no bleeding - Omit warfarin and give 1-5mg PO vitamin K
| bleeding - Omit warfarin and give 1-5mg IV vitamin K
82
Formula for serum osmolality?
2(Na + K) + urea + gluc
83
BB Ci?
hypotension, bradycardia, asthma, and acute heart failure
84
Ccb ci?
hypotension, bradycardia, and peripheral oedema
85
AED SEs : lamotrogine
Rash, rarely Stevens–Johnson syndrome
86
AED SE: carbamazepine
Rash, dysarthria, ataxia, nystagmus, ⇓Na
87
AED SE: phenytoin
Ataxia, peripheral neuropathy, gum hyperplasia, hepatotoxicity
88
AED SE: sod valproate
Tremor, teratogenicity, weight gain
89
AED SE: levetiracetam
Fatigue, mood disorders and agitation
90
What to check before prescribing azathioprine or 6-mercaptopurine?
Thipurine S-methyl transferase (TPMT) levels.
Need for metabolising. Increases risk of liver and bone marrow toxicity
Lower dose aza if TPMT low
Methotrexate if TPMT absent
91
CI to laxatives?
bowel obstruction
92
Laxatives: Stool softener?
Good for faecal impaction; reduced gut motility
eg. docusate sodium (stimulant at higher levels) Arachis oil (rectal)
CI: arachis oil - nut allergy
93
Laxatives: bulking agents?
can take days to develop effect
eg. isphagula husk; usually for colonic atonic, reduced gut motility.
CI isphagula husk - faecal impaction
94
stimulant laxatives
nb may exacerbate abdominal cramps
eg. Senna, bisacodyl
ci: bisacodyl - Acute abdominal
95
osmotic laxatives
max exacerbate bloating
eg. lactulose, phosphate enema
CI to phosphate enema - acute abdomen, inflammatory bowel disease
96
relief for chronic non-infective diarrhoea
loperamide 2mg oral up to 3 hourly
| or codeine 30mg oral up to 6 hourly which will also give pain relief.
97
drug induced neutropenia, eg?
carbimazole
| carbamazepine
98
CI for prescribing COCP?
age >35 (avoid age >50), smoker, and BMI >30 kg/m2, family history of venous thromboembolism in a first degree relative <45 years of age, long-term immobilisation, and history of superficial thrombophlebitis.
99
patient with carbamazepine wants contraception. what to consider?
make sure meds are not oral affected by enzyme inducing drugs including carbamazipeine.
particularly, avoid COCP as efficacy affected.
Parenteral progesterone only best
100
ramipril and pregnancy?
teratogenic in 1st trimester. prescribe labetalol instead
101
tamoxifen
- hot flushes are SE
- increases risk of endometrial ca
- increases risk of VTE
- increases efficacy of warfarin, so increases INR
102
sulphnylureas and hypos?
eg. gliclazide
| increases risk of hypoglycaemia. Do not take at bedtime as more risk of nocturnal hypos
103
what not to take with methotrexate?
no folate anatagonsits!
| eg. trimethoprim,co-trimoxazole
104
warfarin tablets: colour and dose?
white (0.5 mg), brown (1 mg), blue (3 mg), and pink (5 mg
105
steroids, what to prescribe with ?
- risk of osteoporosis if >3 months, prophylaxis with bisphosphonate
- gastric irritation if at risk, PPI or H2 anatgonist
106
steroids - at risk of what?
- long term therapy increases risk of hyperglycaemia ; monitor BMs
- risk of osteoporosis
- risk of gastric irritation/ulcers
- risk of HTN
- if stopped suddenly, addisonian crisis
107
T1DM and illness
when unwell, blood glucose increases; therefore, higher basal doses are required. Failing to do so will increase the risk of diabetic ketoacidosis. Conversely, if patients reduce their oral intake (which many will when ill), there is a risk of hypoglycaemia if the insulin intake is not decreased.
108
if rx bisphosphonates and calcium (eg. alendronic acid and adcal) beware what?
ca salts reduce absorption of bisphosphonates and should not be taken at same time of day.
109
combined oestrogen progesterone HRT, Breast ca risk lower or higher?
higher, esp if continuous HRT preparation
110
1% solution means what?
1g in 100ml
111
1 in a 1000 meaning>
1g in 1000ml
112
oliguric patient with tachycardia, normal BP and raised na, k, ur and creat. What to prescribe?
fluids as oliguric + tachy
no hypotensive, so crystalloid (normal saline, harmans, or 5% dex)
as na and k raised, give 5% dex
as tachy, oliguric, deranged u&e, she is very dehydrated : prerenal aki.
so give 500ml iv challenge or 1l stat over 1 h.
113
what time of day to give diuretics?
in the morning to prevent diuresis at night
114
first drug to give to lower K in hyperkalaemia?
short acting insulin eg.
novorapid 10 units in 100 ml of 20% dextrose over 30 min IV
(could do in 50ml of 50% dex but irritates veins)
115
levetiracetam SE?
Worsens depression
116
CI for metformin?
creatinine >150mmol/l cause lactic acidosis
117
RFs increasing risk of myopathy with statins ?
a personal or family history of muscular disorders, previous history of muscular toxicity, a high alcohol intake, renal impairment, hypothyroidism, and in the elderly
118
what to check when Rx simvastatin?
| when rf of myopathy and no rfs
ck if rf
alt if no rf (transaminases (i.e. ALT or AST) should be checked 3 and 12 months after starting treatment (by requesting liver function tests (LFTs)).
119
SE of vancomycin?
nephrotoxicity and ototoxicity.
| rarely, neutropenia (needs at be on more than 1 week), thrombocytopenia
120
what to check before commencing vancomycin?
u&e
| renally excreted.
121
electrolyte change and Li toxicity?
Sodium depletion is known to increase the risk of lithium toxicity
122
what do If LFT abnormal and RA
do not give methotrexate.
| risk of liver cirrhosis
123
what to check before commencing olanzapine?
- prolactin (for all antipsychotic drugs)
- lipids and BMI
- fasting blood glucose (risk of hyperglycaemia and DM)
124
what to check before commencing amiodarone?
- T3, T4, TSH
- LFTs
- CXR
- serum K
125
CI to carbimazole?
- pregnancy (congenital malformations if in 1st trimester)
| - acute pancreatitis hx (as can cause it)
126
SE heparin?
Haemorrhage (especially if renal failure or <50 kg), heparin-induced thrombocytopaenia
hyperkalaemia - esp dalteparin and all heparins(due to inhibition of aldosterone synthesis)
127
what to prescribe with warfarin initially?
Haemorrhage (note that ironically warfarin has a procoagulant effect initially, as well as taking a few days to become an anticoagulant; thus heparin should be prescribed alongside warfarin and continued until the INR exceeds 2
128
SE aspirin
Haemorrhage, peptic ulcers and gastritis, tinnitus in large doses
129
digoxin SE?
Nausea, vomiting and diarrhoea, blurred vision, confusion and drowsiness, xanthopsia (disturbed yellow/green visual perception including ‘halo’ vision)
130
K and digoxin?
lower with high K
Digoxin competes with potassium at the myocyte Na+/K+ ATPase, limiting Na+ influx. Since Ca2+ outflow relies on Na+ influx, Ca2+ accumulates in the cell. This lengthens the action potential and slows the heart rate. This summary is important because changes in serum K+ at the receptor can compete with digoxin; low K+ augments digoxin effect. High levels limit the effect
131
amiodarone se
Interstitial lung disease (pulmonary fibrosis), thyroid disease (both hypo- and hyperthyroidism), skin greying, corneal deposits
132
haloperidol SE
Dyskinesias, e.g. acute dystonic reactions, drowsiness
133
fludrocortisone SE
Hypertension/sodium and water retention
134
statin SE
Myalgia∗, abdominal pain, increased ALT/AST (can be mild), rhabdomyolysis (can be just mildly increased creatine kinase though)
135
Mx of statin induced myalgia?
exclude rhabdomyolysis (with creatine kinase (CK) level and urine dip). Otherwise, if symptoms unacceptable or CK very high (>2,000): (i) ensure needs statin, then (ii) reduce the dose; then (iii) switch to other statin with lower risk of myalgia (risk of myalgias: simvastatin > atorvastatin > pravastatin > fluvastatin) or a fibrate.
136
why stop metformin before surgery?
to prevent lactic acidosis in the case of renal compromise.
137
on co-codamol and renal failure?
patient may be drowsy
138
new dx of DMT2 and CKD. what is 1st line drug to start?
gliclazide
| metformin CI if eGFR <30 ml/min
139
when to give blood transfusion for fe def anaemia
- severely symptomatic and cannot wait for effect of oral iron replacement (in fe def Hb rises by 10g/l/week on oral fe replacement)
- have Hb <70 g/L; <100g/L in IHD
140
what are examples of oral Fe replacement?
ferrous sulphate/gluconate/fumarate etc.
141
se of oral fe replacement ?
constipation ; most common cause of non compliance
also give laxative
also, offensive black stools
142
how long to have oral fe replacement?
until hb normal range, then for further 3 months
143
steroids and fbc abnormality?
leucocytosis
144
drug which increases phenytoin conc?
chloramphenicol
145
severe flare of UC?
>6 bowel motions/day and systemically unwell
| first line tx is iv hydrocortisone 100mg 6 hourly
146
alcohol in DM
life threatening hypoglycaemia
147
electrolyte imbalance and digoxin toxicity?
low K predisposes to digoxin toxicity
148
indication to stop fluoxetine in pt?
rash! - impending systemic reaction?
149
SE of microgynon?
wt gain, irritability, new headaches , htn
150
NMS, esp occulogyric crisis, what dx?
procyclidine
151
PONV first line?
ondansetron
152
SE of ondansetron?
prolongation of QTc
| use cyclizine instead.
153
if fluid challenge, what dose in what time?
500ml in less than 15 mins
| or IL in less than 30 mins
154
eplenerone and ciclosporin
| which electrolyte abnormality?
hyperkalaemia
155
ankle oedema drug causes?
amlodipine, naproxen
156
drugs increasing conc of digoxin?
amiodarone, ccb, spiro, quinine
157
drugs causing digoxin tox by hypokalaemia, hypomagnesia>
loop and thiadie diuretics
158
interaction with levothyroxine?
ca and fe salts reduce efficacy of levo
| rx at diffeent time of day.
159
DRESS syndrome?
= drug reaction with eosinophilia and systemic symptoms.
eosinophilia, systemic symps including. fevr, lymphadenopathy, liver dysfunc.
example of delayed hypersensitivy reacion type IV.
common drug previpirants - allpurinol, AEDs (eg. carbamazepine), sulphonamides (co-trimoxazole)
160
AGEP
acute genralised exanthematous puStulosis (AGEP)
severe cutaneous reaction secondary to abx.
usually penicillin abx and sulphonamides (eg. trimethoprim)
associated with liver dysfunc
161
SLUDGE symptoms ?
SLUDGE (Salivation, Lacrimation, Urination, Defecation Gastrointestinal upset: emesis]
Remember if on anti-muscarinic, can cause opposite of above (esp if elderly)
162
CI to COCP?
Uncontrolled hypertension (particularly ≥160 / ≥100)
Migraine with aura (risk of stroke)
History of VTE
Aged over 35 and smoking more than 15 cigarettes per day
Major surgery with prolonged immobility
Vascular disease or stroke
Ischaemic heart disease, cardiomyopathy or atrial fibrillation
Liver cirrhosis and liver tumours
Systemic lupus erythematosus (SLE) and antiphospholipid syndrome
BMI above 35 is UKMEC 3 for the combined pill
163
1 missed pill for cocp?
>72 hours since last pill
(missed pill means more than 24 hours late)
take missed pill asap, no extra contraception needed.
(only need extra if >1 pill missed)
164
1 missed pill for traditional POP?
>26 hours since last pill
(missed pill means more than 3 hours late)
take missed pill asap + extra contra for 48 hrs
165
1 missed pill for desogestrel POP?
>36 hours late since last pill
(missed pill means more than 12 hours late)
take missed pill asap + extra contra for 48 hours
166
drugs causing SJS/TEN?
anticonvulsants, sulfa-containing drugs, antibiotics, nonsteroidal anti-inflammatory drugs, and uric acid-lowering agents
167
drugs causing DRESS?
anticonvulsants, anti-infectious (antibiotics, antituberculosis, and antiviral) agents, sulfonamides, and uric acid-lowering medications
168
drugs causing AGEP (acute generalised exanthematous pustulosis) ?
pristinamy- cin, ampicillin/amoxicillin, quinolones, hydroxychloroquine, anti-infective sulfonamides, terbinafine, and diltiazem
nb think lesions + fever + leucocytosis
169
drugs causing GBFDE (generlaised bullous fixed drug eruptions) ?
antibiotics, including cephalosporins, penicillins, and anti-infective sulfonamides, followed by nonsteroid anti-inflammatory drugs
170
aspirin ci?
<16 = reye's syndrome
active peptic ulcers (beware when hx)
hx of hypersensitivity to aspirin or any nsaid
avoid in preg (3rd tri) and BF if possible
bleeding disorder
haemophilia
171
SE of warfarin?
```
haemorrhage
teratogenic, but can use in BF
skin necrosis
purple toes
heparin induced thrombocytopaenia
hyperkalaemia
```
172
heparin (unfractionated) v LMWH?
both parenteral forms
Heparin IV or SC ; LMWH SC
Heparin initiates rapidly + short acting, and easily reversible
LMWH longer acting, but harder to reverse
LMWH - reduced risk of heparin induced thrombocytopenia
173
Periop and warfarin; what do?
stop 5 days before. day of op if INR >/= 1.5, give IV vit K PO
restart warfarin evening post op or next day if haemostasis achieved.
If high risk of VTE (vte within last 3/12, AF with TIA/stroke, mitral mechanical valve) give bridging therapy with LMWH tx dose. this needs to be stopped 24 h before surgery.
174
Paracetamol - cautions?
body wt <50kg
chronic alcohol consumption
chornic dehydration
chronic malnutrition
175
PRN morphine dose/breakthrough pain morphine dose?
1/6th of 24hr morphine dose
repeat 2-4 hrs as required, max 6 times in a day
fentanyl also licensed for breakthrough pain
176
morphine oral dose to parenteral dose relation ?
parenteral dose 1/2 of oral dose
177
BDZ and opioid?
cause additive CNS depression - drowsy aand resp depression
| do not co prescribe of possible
178
when to use CrCl rather than eGFR?
for toxic drugs, elderly patients and patients at extremes of muscle mass (BMI <18 or >40)
179
Short acting BDZ?
Eg. temazepam
act for shorter time and have no hangover effect next day.
good if hepatic impairment
worse withdrawal effect than with long acting BDZ
180
Drugs commonly causing urinary retention:
| esp if post op and old
```
morphine
anticholinergics (antipsychotics, antidepressants, anticholinergic, detrusor relaxants)
GA
alpha adrenoceptor agonists
BDZ
NSAID
CCB
antihistamine
alcohol
```
181
Started on statin and ALT raised, do you stop?
if ALT raised <3 times upper limit, continue statin at same dose.
if >3 times, stop statin
182
high trough pre dose, what do?
increase dosing period
183
high peak post dose , what do?
decrease dose
184
interactions with OCP?
all anticonvulsants of older gen except sodium valporate (newer like lamotrigine not liver enzyme inducres but sitll should be avoided)
rifampicin (liver inducer) - including in rifabutin
griseofulvin - contra failure and menstrual irregularities. (antifungal)
185
indications for sodium bicarb infusion in TCA overdose ?
metabolic acidosis
neuro - sirzures, neuroexcitability
cardiac - broad qrs/arrhythmia
hypotension
186
metronidazole + alcohol?
disulfiram like reaction - flushing, headache, tachy
| avoid alcohol while on it + 48h after stopping
187
hypoglycaemia and pt unconcious, what do?
```
glucose 20% 50-100ml (or gluc 10% 100-200ml 2nd line)
given stat (15 min)
```
188
DKA, what insulin?
soluble insulin 50 units in sodium chloride 0.9% 50ml by infusion at rate of 0.1 units/kg/h
